P1074: PRIMARY REFRACTORY HODGKIN’S LYMPHOMA: A MOROCCAN MONOCENTRIC RETROSPECTIVE STUDY
Authors: M. Ababou, A. Hammani, A. Siham, W. Elfaria, E. M. Mahtat, S. Jennane, H. EL Maaroufi, K. Doghmi
Journal: HemaSphere (2022)

Background: Primary refractory Hodgkin’s lymphoma (PRHL)is defined as disease progression during initial first-line therapy or early relapse of less than 3 months [1], this entity is a therapeutic challenge for hematologists, as the response rate to second-line therapy remains lower (51% vs. 83%, P < 0.0001)[2] Aims: Compare different parameters between patients with PRHL and patients with non-PRHL to reveal factors that could predict the primary refractory character of our patients. Evaluate the evolution in terms of therapeutic response and survival of our patients with PRHL compared to non-PRHL Methods: This is a monocentric retrospective descriptive study that collected all the files of patients followed for Hodgkin Lymphoma at the clinical hematology department of the Military Hospital of Instruction Mohammed V in Rabat between January 2010 and December 2020. Their epidemiological, clinical and prognostic characteristics were recorded, and the efficacy and tolerance of the therapies used were evaluated. We used the t-student, Mann-Whitney, χ2 tests (or Fisher’s exact test) to compare the differences between PRHL and non-PRHL patients. To assess the difference in survival between the two groups, we used the Log-rank test on Kaplan-Meier survival curves.Treatment outcomes were measured in terms of response rate, overall survival (OS) and progression-free survival (PFS). Statistical analyses were performed using JAMOVI software (version 1.6) Results: Classical Hodgkin lymphoma was diagnosed in 122 patients. 27 patients were primary refractory (22.1%). Our comparison between the group of PRHL and non-PRHL patients in terms of age, sex, time to consultation, performance status (PS) score, clinical signs at admission, histological subtype, presence of Bulky mass on chest X-ray, the Ann Arbor stage and the prognostic risk group did not show any significant difference, which makes the identification of primary refractory patients in pre-therapy a difficult challenge. In our serie 83(68%) patients were re-evaluated at 2 courses by PET-Scan (Positron Emission Tomography, 45(54.3%) patients were in Complete Remission (CR), 34(41%) in Partial Remission (PR). Comparing PRHL and non-PRHL patients according to the response at 2 courses, a highly significant difference was observed (p=0.001). Using a univariate logistic regression model, we found that a PR at 2 courses was more likely to be PRHL than a complete response (OR= 4.95; CI95% [1.55-15.78]; p=0.007). At the end of first-line treatment, 77.1% of all patients achieved complete remission, 11.5% achieved partial response, 1 patient had a stable response and 10.6% were in progression. The overall response at the end of treatment for PRHL patients was 44.4% vs 93.6% for the non-PRHL group (p<0.001). 10.7% of patients relapsed within a median of 23 months. With a median follow-up of 65.5 months, the OS and PFS of all patients at 5 years were 91.2% and 90.6% respectively. Comparing primary refractory and non-refractory patients, the OS at 5 years was 73% [56.2-94.8] vs 96.5% [92.7-100] (p<0.0001) (Figure 1). Image:Summary/Conclusion: Primary refractory Hodgkin’s lymphoma remains a form with a poor prognosis, the overall 5-year survival of this form in our series is 73% compared to 96.5% for the non-PRHL patients. PET-2 may be a predictive step for this form, studies are needed to identify the place of immunotherapy in the management of these patients